右室舒张功能的衰老演变规律脉冲多普勒超声心动图研究

目的　检测右室舒张功能的随龄演变规律。方法　用脉冲多普勒超声心动图记录320例健康知识分子的三尖瓣血流频谱,年龄范围26～90岁。结果　右室舒张功能指标Er、EMVr、EDVr、Eir、13FFr、NPFRr、ErAr、随年龄增加分别降低,而EDTcr、Ar、Air、AFFr、随年龄增加而增加。EATcr、EAVr、在各年龄组中无变化。结论　右室的舒张功能年龄增长而减低     

Thoracic Aortic Aneurysms: Role of Echocardiography

This article describes the evolving role of echocardiography for the detection and evaluation of thoracic aortic aneurysms. A brief summary of the clinical, anatomical, and pathological features of the etiologic categories of thoracic aneurysms is presented. The advantages and limitations of echocardiography and its comparison with other techniques (computed tomographic scanning, magnetic resonance imaging, and aortography) are discussed.     

Supine Bicycle Exercise Echocardiography: A Potent Immediately Available Tool for Detection and Localization of Myocardial Ischemia for the Initial Cardiologist

Background: Exercise echocardiography (EE) is being used increasingly as an investigative technique now that dynamic images can be captured digitally. Its equivalent reliability with scintigraphic methods has been demonstrated in a hospital setting. This study analyzes its impact on daily practice. Materials and Methods: Standardized progressive stress was produced by supine bicycle ergometry. Echocardiographic images of complete cardiac cycles were obtained in standard apical and parasternal short-axis views before, during, and after maximum effort, and digitized for simultaneous analysis of synchronized images at rest and during exercise. Two hundred sixteen patients (175 men and 41 women; mean age 58 ± 10 years) were studied. Results: Image quality was suboptimal in 4 cases. In the remaining 212 cases, ischemia was detected in 91 cases, and the test was negative in 114 cases and doubtful in 7 cases. Control by selective coronary angiography, as indicated by the clinical situation, was performed in 52 cases. In this particular group, EE showed 87% sensitivity, which is significantly higher than the 59% recorded for conventional exercise testing (P > 0.0001). Conclusions: EE by bicycle ergometer in the supine position is a valid, noninvasive investigative technique that can be used in an outpatient situation (feasibility 95%) since it is readily available. Its value appears to be greatest in cases in which exercise ECG is not conclusive. A negative result enables the initial cardiologist to reassure the patient immediately, which has been demonstrated in the literature to have favorable prognostic value.     

Left Ventricular Thrombus After Pregnancy: Choice of Surgical Access Using Dynamic Three-Dimensional Echocardiography

Two idiopathic thrombi loosely attached to the left ventricular wall were detected by dynamic three-dimensional echocardiography. Because the thrombi were shown to be lobulated and extremly mobile, urgent surgical treatment was mandatory. Three-dimensional image reconstruction enhanced appreciation of left ventricular thrombi by enabling accurate imaging of the spatial relationship between the thrombus, the myocardial wall, and the valvular apparatus, so that the most advantageous surgical access could be chosen.     

Ultrasound Densitometric Analysis: Comparison Between an Online Digital Acquisition Acoustic Program and an Offline Analog Program

Videodensitometric analysis of myocardial contrast echocardiography is traditionally performed off line. Recently, an online contrast ultrasound analysis system, Acoustic Densitometry (Hewlett-Packard), was introduced. We compared pixel intensities acquired with Acoustic Densitometry to pixel intensities derived from videodensitometry. A tissue phantom was imaged in phase I using three transducer frequencies (2.5, 3.5, and 5.0 MHz). In phase II, an in vitro flowing tube model with various concentrations of Albunex® was imaged at two flow rates, 0.6 and 1.2 m/sec, and at two transducer frequencies, 2.5 and 3.5 MHz. The relationship between pixel intensities yielded by the two systems for identical ultrasound signals was determined with linear regression. Intensities derived with Acoustic Densitometry strongly correlated with those derived from the offline videodensitometry system. The intensities were related by a predictive multiplicative factor based on display characteristics of the two systems. These results suggest that semiquantitative, online perfusion analysis with Acoustic Densitometry is as sensitive as analysis offline with videodensitometry.     

Relationship of ambulatory blood pressure monitoring data to echocardiographic findings in haemodialysis patients

BACKGROUND: The present study was performed to assess the value of ambulatoryblood pressure monitoring (ABPM) in determining the adequacyof blood pressure (BP) control, and its relationship to echocardiographicfindings in haemodialysis (HD) patients. METHODS: We studied 40 non-diabetic adult patients who had been on regularHD treatment for a median duration of 43 months. Twenty-four-hourABPM was performed using a non-invasive ABP monitor (Pressurescan,ERKA). Casual BP (cBP) was defined as the average of two measurementsobtained at two HD sessions, one preceding and one followingthe ABP recordings, and was calculated for both the predialysisand postdialysis phases. Two-dimensional and M-mode echocardiographywere performed in each patient to determine interventricularseptal thickness (IVS), left ventricular posterior wall thickness(LVPW), left ventricular fractional shortening (FS), and leftventricular mass index (LVMI) RESULTS: According to average 24-h BP levels, 50% of the patients hadsystolic hypertension (HT) (>139 mmHg), and 72.5% had diastolicHT (>87 mmHg), while only 25% had been diagnosed as HT bycBP measurements (P>0.01 and P>0.0001 respectively). Diurnalvariation in BP was not present in about 80% of the patients.Echocardiography was normal in only four patients (10%). LVMIand LV wall thickness were correlated to ABPM data better thanto cBP measurements. Using stepwise linear regression analysis,LVMI and FVS were positively correlated with systolic BP load(P> 0.0001 and P=0.0001 respectively), and LVPW was positivelycorrelated with night-time systolic BP level (P>0.001). CONCLUSIONS: ABPM is necessary to assess the adequacy of BP control, andis well correlated to end-organ damage of HT in HD patients.     

Definition of inseparably fused ventricular myocardium in thoracopagus: Fetal echocardiographic utility and pathologic refinement

Summary Correlative echocardiographic and pathological findings in a thoracopagus with conjoined hearts are reported. One twin had tricuspid atresia with discordant atrioventricular connections and concordant ventriculoarterial connections. The morphologic right ventricle was hypoplastic and there was a large muscular ventricular septal defect. The other twin had hypoplasia of the mitral valve anulus and left ventricle with double-outlet right ventricle and pulmonary valve atresia. The tricuspid valve was severely insufficient in part because of a large orifice and redundant, elongated leaflets with abnormal chordal attachments. The left ventricles of these two twins shared a perforated common free wall with at least two large defects allowing mixing of the circulations at that level. Not all anatomic details were established conclusively by fetal echocardiography; however, sufficient diagnostic information was obtained to support a decision not to aggressively resuscitate these twins after elective cesarean delivery at 31 weeks' gestation.     

Left atrial thrombi in non-rheumatic atrial fibrillation: assessment of prevalence by transesophageal echocardiography

To determine the prevalence of left atrial thrombus in hospitalized patients with non-rheumatic atrial fibrillation, 48 patients were consecutively studied with single-plane transesophageal echocardiography. There were 23 males (48%) and 25 females (52%). The mean age was 66±11 years (range 43–87). Thrombus was detected in 13 patients (27%) 11 were confined to the left atrial appendage, 1 to the atrial body and appendage, and 1 to the left upper pulmonary vein. Prevalence of atrial thrombus was not different among those patients with or without previous stroke [4/16 (25%) vs 9/32 (28%), p=NS] or between patients > 65 years and patients 65 years old (p=NS). Atrial thrombus was detected more frequently in patients with reduced left ventricular global systolic function than in those with normal function [7/14 (50%) vs 6/34 (17%), p<0.05]. In patients with spontaneous contrast echoes in the left atrium, thrombi were visualized more often than in those without spontaneous echoes [10/24 (41%) vs 3/24 (12%), p<0.05]. The finding of the atrial spontaneous contrast echoes was more frequent among patients with reduced left ventricular global systolic function [11/14 (78%) vs 13/34 (37%), p<0.02].We conclude that in hospitalized patients with non-rheumatic atrial fibrillation the prevalence of left atrial thrombus is high. Reduced left ventricular global systolic function identifies a subset of patients at high risk for formation of thrombus in the left atrium.     

Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dipyridamole echocardiography

Dipyridamole echocardiography test (DET) has gained acceptancedue to its safety, feasibility, diagnostic accuracy and prognosticpower. The main limitation of the test is a less than idealsensitivity in some patient subsets, such as those with limitedcoronary artery disease. Atropine with dipyridamole might theoreticallycombine to become a synergistic ischaemic stress test, by increasingmyocardial oxygen demand through chronotropic stress and byreducing flow supply through a shortening of the diastolic intervalunder maximal coronary vasodilation. The aim of this study wasto assess the effects of the addition of atropine to DET. Threehundred and twenty-one patients (age=58±9 years), referredfor testing in the echo lab, were initially studied by DET.Of these, 151 were stopped during or within the 2 min followingdipyridamole infusion because of achievement of a predeterminedend-point: obvious echocardiographic positivity (n = 137), severechest pain (n = 3), diagnostic ST segment changes (n = 7) orlimited side effects (n = 4). In another three cases, atropinewas not given due to a history of glaucoma or severe prostatichypertrophy. In the remaining 167 patients with a negative DETtest, atropine (0.25 mg intravenously, repeated every min upto a maximum of 1 mg, if necessary) was added, starting 3 minafter the end of the dipyridamole infusion. The dipyridamole-atropineecho test (DETA) was positive in 32 and negative in 135 patients,and no major side effects occurred in any patient. The peakheart rate was significantly higher during DETA than with DETalone (108±16 vs 86±14 beats . min^–1; P<0.0001).In the subset of 178 patients who were studied while not takingantianginal therapy, who had no prior myocardial infarctionor revascularization procedure and who underwent coronary catheterization,independently of the test results, coronary angiography showednormal coronary arteries in 48 patients and significant coronaryartery disease (CAD) ( 50% luminal reduction in at least onemajor coronary vessel by quantitative coronary arteriography)in 130 patients—with single-, double- and triple-vesseldisease in 56, 47 and 27 patients, respectively. The sensitivitywas 96/130 for DET and 110/130 for DETA (72 vs 85%, P<0.01)while the specflcity was 96% and 92% (P=ns), respectively. Theaddition of atropine to dipyridamole, which causes further chronotropicstress to the myocardium already challenged by flow maldistribution,is well tolerated and safe, and increases the sensitivity ofthe test for the detection of coronary artery disease with noloss in specificity.     

Reference ranges of echocardiographic measurements in the Dutch population

Reference ranges for echocardiographic measurements were determinedin 609 healthy Dutch subjects, using height, weight, age, sex,RR-interval and blood pressure (in adults only) as determinants.Endsystolic as well as end-diastolic measurements of the aorticroot as well as left ventricular inner diameter, posterior andseptal thickness were taken, as was the left atrial end-systolicdiameter. Multiple linear regression was performed of the form: =A.(age)^B.(height)^C.(weight)^D.(RR-interval)^E.(sex)^F. The residuals were calculated in order to determine the percentilelimits by means of linear interpolation. Sex and weight weresignificant determinants in all the echocardiographic parametersstudied. The results were presented twofold, with a simple versionfor males and females separately, using only weight as a determinantand allowing graphical presentation, and secondly a complexversion taking into account all determinants, which can onlybe solved with help of a calculator.